Time Elapsed For Switching From Oral Antidiabetic Therapy to Insulin Therapy in Type 2 Diabetic Patients and Evaluation of The Factors Affecting This Period

Abstract

Background We aimed to determine the time elapsed for switching from oral antidiabetic therapy to insulin therapy in patients with type 2 diabetes mellitus and the factors that affect this period. Material and Methods Three hundred fifteen patients with type 2 diabetes mellitus who were followed up in the diabetes outpatient clinic were included in the study. The gender, education level, age of onset of diabetes, presence of hypertension, smoking and body mass index of the patients were examined, and the effects of these variables on time elapsed for switching to insulin therapy were analyzed in three phases. Results Three hundred fifteen patients (117 males, 198 females) were enrolled in the study. The mean time elapsed for switching from oral antidiabetic therapy to insulin therapy was 9.93±6.67 years. The effects of education level, age at the onset of diabetes, presence of hypertension, and body mass index on time elapsed for switching to insulin therapy were found to be statistically significant (p<0.05); whereas the effects of gender and smoking were not significant (p>0.05). The time elapsed for switching to insulin therapy shortened as the education level, the age at the onset of diabetes, and body mass index level increased. It was found that hypertension in patients with type 2 diabetes mellitus prolongs the time elapsed for switching to insulin therapy. Conclusion The body mass index level, presence of hypertension, education level and age at the onset of diabetes were the significant factors affecting the time elapsed for switching to insulin therapy.

Keywords

• Type 2 Diabetes Mellitus
• Oral antidiabetics
• Insulin therapy

References

1. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, Colagiuri S, Guariguata L, Motala AA, Ogurtsova K, Shaw JE, Bright D, Williams R; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019 Nov;157:107843. doi: 10.1016/j.diabres.2019.107843.
2. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 Suppl 1(Suppl 1):S67-S74. doi:10.2337/dc13-S067.
3. Saisho Y. β-cell dysfunction: Its critical role in prevention and management of type 2 diabetes. World J Diabetes. 2015;6(1):109-24. doi:10.4239/wjd.v6.i1.109.
4. Alejandro EU, Gregg B, Blandino-Rosano M, Cras-Méneur C, Bernal-Mizrachi E. Natural history of β-cell adaptation and failure in type 2 diabetes. Mol Aspects Med. 2015;42:19-41. doi:10.1016/j.mam.2014.12.002.
5. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, Zinman B; American Diabetes Association; European Association for Study of Diabetes. Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: a consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2009 Jan;32(1):193-203. doi: 10.2337/dc08-9025.
6. Sherwani SI, Khan HA, Ekhzaimy A, Masood A, Sakharkar MK. Significance of HbA1c Test in diagnosis and prognosis of diabetic patients. Biomark Insights. 2016;11:95-104. doi:10.4137/BMI.S38440.
7. Hanssen KF. Blood glucose control and microvascular and macrovascular complications in diabetes. Diabetes. 1997 Sep;46 Suppl 2:S101-3. doi: 10.2337/diab.46.2.s101.
8. Sreenan S. HbA1c levels exceed recommended targets prior to initiation or intensification of insulin therapy in clinical practice: baseline data from the PREDICTIVE™ European cohort. EASD 2006, Abstract 0897.

9. Peyrot M, Rubin RR, Lauritzen T, Skovlund SE, Snoek FJ, Matthews DR, Landgraf R, Kleinebreil L; International DAWN Advisory Panel. Resistance to insulin therapy among patients and providers: results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care. 2005 Nov;28(11):2673-9. doi: 10.2337/diacare.28.11.2673.
10. Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, Raskin P, Zinman B; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22;353(25):2643-53. doi: 10.1056/NEJMoa052187.
11. Steppel JH, Horton ES. Beta-cell failure in the pathogenesis of type 2 diabetes mellitus. Curr Diab Rep. 2004 Jun;4(3):169-75. doi: 10.1007/s11892-004-0019-3.
12. Unger J, Cole BE. Recognition and management of diabetic neuropathy. Prim Care. 2007 Dec;34(4):887-913, viii. doi: 10.1016/j.pop.2007.07.003.
13. Home P, Boulton A, Jimenez J, Landgraf R, Osterbrink B, Christiansen JS; on behalf of the Worldwide Initiative for Diabetes Education (WorldWIDE). Issues relating to the early or earlier use of insulin in type 2 diabetes. Pract Diab Int. 2003 March;20(2):63-71. doi: 10.1002/pdi.433.
14. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet. 1998 Sep 12;352(9131):837-53. Erratum in: Lancet 1999 Aug 14;354(9178):602.
15. Weng J, Li Y, Xu W, Shi L, Zhang Q, Zhu D, Hu Y, Zhou Z, Yan X, Tian H, Ran X, Luo Z, Xian J, Yan L, Li F, Zeng L, Chen Y, Yang L, Yan S, Liu J, Li M, Fu Z, Cheng H. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet. 2008 May 24;371(9626):1753-60. doi: 10.1016/S0140-6736(08)60762-X.
16. Alvarsson M, Sundkvist G, Lager I, Berntorp K, Fernqvist-Forbes E, Steen L, Orn T, Holberg MA, Kirksaether N, Grill V. Effects of insulin vs. glibenclamide in recently diagnosed patients with type 2 diabetes: a 4-year follow-up. Diabetes Obes Metab. 2008 May;10(5):421-9. doi: 10.1111/j.1463-1326.2007.00719.x.
17. Brunton S. Initiating insulin therapy in type 2 diabetes: benefits of insulin analogs and insulin pens. Diabetes Technol Ther. 2008 Aug;10(4):247-56. doi: 10.1089/dia.2008.0287.
18. Wright A, Burden ACF, Paisey RB, Cull CA, Holman RR, U.K. Prospective Diabetes Study Group. Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the UK Prospective Diabetes Study (UKPDS 57). Diabetes Care. 2002 Feb;25(2):330-6. doi: 10.2337/diacare.25.2.330.
19. Korytkowski M. When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord. 2002 Sep;26 Suppl 3:S18-24. doi: 10.1038/sj.ijo.0802173.
20. Heinemann L. Overcoming obstacles: new management options. Eur J Endocrinol. 2004 Oct;151 Suppl 2:T23-7; discussion T29-30. doi: 10.1530/eje.0.151t023.